Ⅱb型早期胃癌の1例―潰瘍瘢痕と鑑別のむずかしい症例

A CASE REPORTOF Ⅱb TYPE EARLY GASTRIC CARCINOMA ASSOCIATED WITH A HEALED GASTRIC ULCER

Ⅰ．まえがき

　Ⅱb型早期胃癌のように，ほとんど粘膜面に凹凸の変化を呈さない病変では，現在の進歩したX線診断技術をもってしても，その確診は極めて困難である．幸に本例では，胃潰瘍が合併していたため，病変部の存在は容易に気付くことが出来た．しかし，X線，内視鏡の所見からは，悪性を疑いつつも確診所見に乏しく，特に悪性変化の及ぶ範囲の決定が出来ず，結局，胃生検により癌を証明し，手術を施行した．（昭和42年11月6日手術）

　The patient, a 45 years old female, has about five years long history of gastric distress. In the interim she had been twice examined by her doctor radiologically as well as endoscopically, and was diagnosed as gastroptosis with atrophic gastritis. Two months ago she began to complain of persistent dull pain in the epigastrium. Gastric examination at that time suggested some malignant tendency around a small healing ulcer, so that she was referred to the authors’ hospital.

　While and endoscopic findings were strongly suggestive, but not conclusive of, cancerous invasion to the gastric mucosa, gastroscopic biopsy proved successful in revealing cancerous tissues there. Macroscopical observation of the resected specimen shows a small, slender mucosal depression on the lesser curvature 65 mm proximal to the pyrolus. It is accompanied with convergence of mucosal folds indicating a healed ulcer. In addition to this, an irregular shaped, discolored Inucosal change with rough surface is seen to extend distally from the ulcer. It stretches continuously to the marginal atrophic mucosa with undetermined boundary.

　Histological study of the specimen discloses that cancerous infiltration is limited to the mucosa and a major part of the infiltration is spread distally from the ulcer scar. Only a very small cancerous area is seen proximally from the scar. The extent of malignant invasion almost completely corresponds with that of the rough-surfaced lesion macroscopically observed. The view of the section indicates that this cancerous infiltration is flatly spread with no elevation nor depression of the mucosa as compared with the marginal non-cancerous atrophic mucosa. There is no metastasis to the regional lymph nodes.